US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 56
                           PROMPT PAYMENT OF CLAIMS
    41-5602.  PROMPT PAYMENT OF CLAIMS. (1) Except as otherwise specifically
provided in this chapter, an insurer shall process a claim for payment for
health care services rendered by a practitioner or facility to a beneficiary
in accordance with this section.
    (2)  If a beneficiary, practitioner or facility submits an electronic
claim to an insurer within thirty (30) days of the date on which service was
delivered, an insurer shall pay or deny the claim not later than thirty (30)
days after receipt of the claim.
    (3)  If a beneficiary, practitioner or facility submits a paper claim for
payment to an insurer within forty-five (45) days of the date on which service
was delivered, an insurer shall pay or deny the claim not later than
forty-five (45) days after receipt of the claim.
    (4)  If an insurer denies the claim or needs additional information to
process the claim, the insurer shall notify the practitioner or facility and
the beneficiary in writing within thirty (30) days of receipt of an electronic
claim or within forty-five (45) days of receipt of a paper claim. The notice
shall state why the insurer denied the claim.
    (5)  If the claim was denied because more information was required to
process the claim, the notice shall specifically describe all information and
supporting documentation needed to evaluate the claim for processing. If the
practitioner or facility submits the information and documentation identified
by the insurer within thirty (30) days of receipt of the written notice, the
insurer shall process and pay the claim within thirty (30) days of receipt of
the additional information or, if appropriate, deny the claim.
    (6)  Any claim submitted pursuant to this chapter shall use the current
procedural terminology (CPT) code in effect, as published by the American
medical association, the international classification of disease (ICD) code in
effect, as published by the United States department of health and human
services, or the healthcare common procedural coding system (HCPCS) code in
effect, as published by the United States centers for medicaid and medicare
services (CMS).
    (7)  This chapter shall not apply to claims submitted under policies or
certificates of insurance for specific disease, hospital confinement
indemnity, accident-only, credit, medicare supplement, disability income
insurance, student health benefits only coverage issued as a supplement to
liability insurance, worker's compensation or similar insurance, automobile
medical payment insurance or nonrenewable short-term coverage issued for a
period of twelve (12) months or less.